{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NICOLE A COPELAND","gend":1,"currentgend":"","add":"7014 W BRIARWOOD AVE","city":"WICHITA","state":"KS","zip":"67212","dob":"1962-08-15","age":"","mstatus":"","insh":"1E66X36AQ57","cliId":"","pno":"3163124063","cno":"","email":"","ename":"","eno":"","pphy":"ANDREA MCCARTY","ppno":3167219500,"pcpadd":"8444 W 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1752","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"","pcpnpi":1063470938,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"1E66X36AQ57","medicaidid":"1E66X36AQ57","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","Farxiga Tab","10 MG","","Select","Select",""],["","","Buspirone Tab","7.5 MG","","Select","Select",""],["","","Ropinirole Tab","2 MG","","Select","Select",""],["","","Metolazone Tab","5 MG","","Select","Select",""],["","","Pregabalin Cap","150 MG","","Select","Select",""],["","","Latanoprost Sol 0.005%","","","Select","Select",""],["","","Mounjaro Inj 12.5\/0.5","","","Select","Select",""],["","","Propranolol Tab","10 MG","","Select","Select",""],["","","Microlet Mis Lancets","","","Select","Select",""],["","","Fluticasone Spr","50 MCG","","Select","Select",""],["","","Albuterol Neb 0.083%","","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Bumetanide Tab","2 MG","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Cipro\/Dexa Sus 0.3-0.1%","","","Select","Select",""],["","","Mounjaro Inj 7.5\/0.5","","","Select","Select",""],["","","Tramadol Hcl Tab","50 MG","","Select","Select",""],["","","Klor-Con M20 Tab","20 MEQ","","Select","Select",""],["","","Mounjaro Inj","5 MG","","Select","Select",""],["","","Furosemide Tab","40 MG","","Select","Select",""],["","","Pot Cl Micro Tab","20 MEQ","","Select","Select",""],["","","Escitalopram Tab","10 MG","","Select","Select",""],["","","Levothyroxin Tab","125 MCG","","Select","Select",""],["","","Cefdinir Cap","300 MG","","Select","Select",""],["","","Amlodipine Tab","5 MG","","Select","Select",""],["","","Ozempic Inj","8 MG","","Select","Select",""],["","","Metoprol Suc Tab","25 MG","","Select","Select",""],["","","Diazepam Tab","2 MG","","Select","Select",""],["","","Bupropion Tab","150 MG","","Select","Select",""],["","","Allopurinol Tab","300 MG","","Select","Select",""],["","","Onetouch Tes Verio","","","Select","Select",""],["","","Contour Tes Next","","","Select","Select",""],["","","Contour Next Mis Gen","","","Select","Select",""],["","","Mounjaro Inj 2.5\/0.5","","","Select","Select",""],["","","Azithromycin Tab","250 MG","","Select","Select",""],["","","Flecainide Tab","100 MG","","Select","Select",""],["","","Amiloride Tab","5 MG","","Select","Select",""],["","","Amox\/K Clav Tab 875-125","","","Select","Select",""],["","","Eliquis Tab","5 MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}